Abstract WP299: Telestroke Program Participation and Improvement in Door-To-Needle Times

Abstract

Background: Telestroke care has become a vital feature of expert stroke care for rural hospitals in recent years. The Telemedicine for Arizona Rural Residents (STARR) program was developed in 2006 by the Mayo Clinic in Arizona in order to provide stroke expertise across the region. However, little data currently exists to determine efficacy of telestroke programs on accepted stroke care metrics, such as door-to-needle times. Hypothesis: Participation of spoke sites in a telestroke program improves stroke care over time, as defined by currently-accepted metrics, such as door-to-needle time. Methods: A retrospective analysis was performed on the telestroke database from Mayo Clinic, Arizona, between the years of 2011 to 2018. Patients who received IV-tPA for an acute ischemic stroke were included in the analysis. Patients who did not have radiographic or clinical symptoms of an acute ischemic stroke, as well as those who did not receive IV-tPA, were excluded from the analysis. Univariate linear regression was performed to look for associations between variables and defined outcomes. Results: 565 patients were identified who received IV-tPA via telestroke consultation and met inclusion criteria between 2011 to 2018. Average last known normal (LKN) to needle time decreased across all sites from 176 minutes in 2011 to 147 minutes in 2018, with univariate linear regression showing a trend of decreased time averaging 3 minutes per year, which was statistically significant (p = 0.0084). Average door-to-needle times decreased from 112 minutes in 2011 to 81 minutes in 2018, with univariate linear regression modeling showing a decreasing trend of 3.5 minutes on average per year (p < 0.001). Conclusions: Telestroke participation may be associated with improved stroke care metrics over time, with our analysis illustrating improved LKN-to-needle and door-to-needle times among participating spoke sites.